Observational studyJournal of pregnancy2026
Ultrasound-Indicated Versus Physical Examination-Indicated Cerclage in Twin Pregnancies Between 24 and 27 + 6 Weeks: An Exploratory Observational Analysis of Pregnancy and Neonatal Outcomes.
Observational study in Journal of pregnancy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
backgroundRecent advancements in assisted reproductive technology and delayed parenthood have led to a surge in twin pregnancies, with a high incidence of preterm birth (PTB) due to cervical insufficiency. Current guidelines recommend cervical cerclage for twin pregnancies before 24 weeks; however, data on cerclage efficacy beyond 24 weeks is scarce.
objectiveThis exploratory, hypothesis-generating study is aimed at examining the associations of cervical cerclage on pregnancy duration and neonatal outcomes in twin pregnancies with a short cervix between 24 and 27 + 6 weeks.
methodsThis retrospective cohort study, conducted between July 1991 and July 2023 at Women's Hospital, Zhejiang University School of Medicine, involved twin pregnancies with a short cervix (≤ 25 mm) during the gestational period ranging from 24 weeks to 27 + 6 weeks. Skilled obstetricians performed cervical cerclage. Data on maternal and neonatal outcomes were collected and analyzed using statistical tests, with statistical significance set at p < 0.05.
resultsA total of 73 twin pregnancies were analyzed. Participants were categorized into ultrasound-indicated cerclage group (n = 22), physical examination-indicated cerclage group (n = 33), and control group (n = 18). The ultrasound-indicated cerclage group showed significantly longer presentation-to-birth intervals (60.77 ± 21.64 days, p = 0.007) and higher birth weights (larger twin: 2273.33 ± 566.09 g, p = 0.026; smaller twin: 2086.90 ± 526.58 g, p = 0.029) compared with the control group. No significant differences were found in gestational age at delivery, Apgar scores, cesarean delivery rates, maternal morbidity, and neonatal morbidity among both groups.
conclusionsUltrasound-indicated cerclage in twin pregnancies at 24-27 + 6 weeks was observed to prolong presentation-to-birth interval and increase birth weight, whereas physical examination-indicated cerclage showed no statistically significant association with the measured outcomes. A randomized controlled clinical trial is needed to validate these findings.
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